Individual
MR. TIMOTHY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2121 SANTA MONICA BLVD, SANTA MONICA, CA 90404-2303
(310) 582-7137
(310) 582-7140
Mailing address
1333 S MAYFLOWER AVE, 2ND FLOOR, MONROVIA, CA 91016-4066
(626) 775-3514
(626) 408-3911
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
G57490
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G574900
—
CA
Enumeration date
09/20/2006
Last updated
09/14/2021
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